| National Provider Identifier [NPI]: | 1639240872 |
| Last Name Of The Provider | MARTY |
| First Name Of The Provider | CHELSY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3200 3RD ST S |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | JACKSONVILLE BEACH |
| Zip Code Of The Provider | 322506096 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 3258 |
| Number Of Medicare Beneficiaries | 619 |
| Total Submitted Charge Amount | 204853.02 |
| Total Medicare Allowed Amount | 193017.31 |
| Total Medicare Payment Amount | 134319.14 |
| Total Medicare Standardized Payment Amount | 134835.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 28 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 2771.04 |
| Total Drug Medicare AllowedAmount | 2742.99 |
| Total Drug Medicare PaymentAmount | 2150.46 |
| Total Drug Medicare Standardized Payment Amount | 2150.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 3230 |
| Number Of Medicare Beneficiaries With Medical Services | 619 |
| Total Medical Submitted Charge Amount | 202081.98 |
| Total Medical Medicare Allowed Amount | 190274.32 |
| Total Medical Medicare Payment Amount | 132168.68 |
| Total Medical Medicare Standardized Payment Amount | 132685.16 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 16 |
| Number Of Beneficiaries Age 65 to 74 | 343 |
| Number Of Beneficiaries Age 75 to 84 | 195 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 360 |
| Number Of Male Beneficiaries | 259 |
| Number Of Non Hispanic White Beneficiaries | 593 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8253 |